What Healthcare Can Learn About Patient Safety from Close Quarters Combat

Most of us will never clear a room full of enemy combatants with a rifle.

But that doesn’t mean we can’t learn from those who do.

Close Quarters Combat training session

In Close Quarters Combat (CQC), there are no small movements. Every motion signals intent. Every step has a purpose. Everyone knows their job — and what happens if they fail.

Healthcare teams, especially in high-risk areas like surgery, emergency care, and labor and delivery, face different threats — but the stakes are just as high. A misstep can cost a life.

If you want to improve patient safety - and performance in general - it’s worth borrowing a few rules from CQC training.

1. Move with purpose

CQC instructors aren’t gentle. They’ll call out slouched shoulders, slow feet, poor posture, and moving without confident intent. Not because they care about military bearing, but because that lack of intent can lead to catastrophic mission failure, including death.

This is why when I practice my own drills I focus on those things. Often, I film my drills so I can critique myself afterwards. I assess my posture, my footwork, my draw, and my movement between targets. I look for smoothness - because smooth is fast - and fluidity. Do my repetitions of the different drills translate to confident movement as seen on the video? The "tape" never lies.

These principles apply to a surgical tech fumbling for a clamp. Or a nurse who hesitates during shoulder dystocia. Or a physician who’s mentally checked out on hour 6 of a long procedure.

So, when I work with hospital teams to improve their processes, I apply the principle of moving, or acting, with purpose. Once we've tweaked an existing process, say a Surgical Time Out, or created a new process such as a face-to-face PreOp-to-OR Handoff, I'll coach the team through several dry runs of the revised process. In those dry runs, as expertise is developed, we'll focus on fluidity and smoothness - removing all unnecessary movement, including pause fillers or unneeded words. Then, I'll video the process being used and we'll watch the recording together. We assess smoothness, efficiency, and confidence - acting and speaking with purpose.

2. Be useful — right now

There’s no time to find your place, rhythm, or "next move" in CQC. You need to know it already.

When practicing my own firearm drills, each session is carefully planned beforehand. I conduct a mental walkthrough of each drill before I ever get to the range. I "plan my practice, then practice my plan." That way I already know my next move in each drill and work on movement with rhythm and fluidity.

It’s the same during a code in a hospital... when severe postpartum bleeding occurs, or a convulsing patient on arrival in the ER.

The people who are most useful in saving lives in those moments aren’t always the smartest, the most experienced, or the most senior. They’re the ones who, at the moment of truth, can step up - and move and act with confidence and purpose. They are able to do the thing that needs to be done, fast and clean.

I use this principle when implementing new healthcare processes. I'll form the team that will conduct the dry runs with the new process the day before our practice sessions and ask them, the night before, to visualize using the new process. I urge them to be very specific in their visualizations to include each action and word spoken. Intentionality coupled with repetitions breeds smoothness. Smooth is fast.

I've found that usefulness, especially in emergency response protocols, isn’t always directly related to credentials. It’s most often about confident contribution to the team - doing the right thing, in the right way, at the right time, in the moment of the truth.

3. Know the worst — before it happens

In CQC, operators visualize bad outcomes ahead of time. They’ve seen the hostage, the explosion, the gunfire — all in their mind — before the mission starts. That's why visualization practice is so important.

It's also why CQC training sessions use "simunitions" (think paint ball guns on steroids), real flash bangs, smoke devices, loud music, and real humans as hostages and bad guys (protected by padding and face shields from the simunitions.) The object is to get to a place where there is "suspension of disbelief" and the scenario is so realistic you forget you are in a training session. I've played the role of a "bad guy" during a CQC session conducted with simunitions. The tight muscles, racing heart rate, and heavy breathing are very real. Realism matters.

When I conduct my own drills, its difficult to replicate this, but I try anyway. I use props - something that simulates an ATM machine, or a car window, or a doorway. If training with colleagues, we'll use a long pole to poke the shooter to induce imbalance. We'll often train around our vehicles. Realism is the key, along with pre-drill visualizations.

Healthcare could use more of that.

The best teams I've worked with, and observed in action are those that systematically rehearse for the "what-ifs." Examples include rehearsing responses to shoulder dystocia, amniotic embolism, or a failed airway.

The best don’t just practice these drills once a year for compliance. They drill until there is unconscious competence.

Just like in CQC, visualization, repetition, and realism help turn chaos into clarity.

4. Your mindset matters to others

In CQC, posture, confidence of movement, fluidity, and eye contact can bolster your team, calm a hostage, or unsettle an enemy combatant.

I think about my mindset in my drills and training. I am not out there just "using a firearm." I'm training with intent. I consciously think about how my drills may save my own life, my family's lives, or the lives of innocents. I know my mindset matters. I approach my drills ready to work.

The same applies in medicine.

Calm breeds calm.

In my work with healthcare teams, I've clearly seen that teams are affected by teammates who come with the proper mindset, ready to work, and who perform with steadiness. A calm scrub nurse steadies the room. A confident resident buys everyone a second to breathe. A focused physician quiets the chaos without saying a word.

It’s leadership born of confidence that comes from a history of superior performance in previous drills and real-life situations, and approaching those opportunities to develop expertise with the proper mindset.

5. Every Door Is a Decision

In CQC, operators don’t just crash through doors. Every door is a decision point. Does the door open in or out? Do I go right or left? Where is the threat most likely to be?

They approach. They open. They enter. With clarity about the next step and taking ownership of the decision they are about to make.

This is true in my own drills as well. Once a bullet has been fired, it cannot be recalled. I, and I alone, am responsible for where it goes and what it does. Every action I take in every drill I do that results in firing a weapon is the result of a series of decisions. I own those decisions.

This principle is also true in healthcare.

When conducting new process drills — whether it’s the OR, the trauma bay, or a delivery suite — I try to make clear that individual team members must own their performance. I want them to ask of themselves...

Am I prepared to move with purpose - confident, smooth, fluid?

Am I ready to be useful because I've got my role wired through repetitive visualizations?

Am I clear on what I'll do if...?

Did I walk through that door and show up in that room like what I'm doing matters?

Because it does. To their performance and to the best outcome for their patients.